Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
2001)
We summarize the facts in the light most favorable to the plaintiff. Andrade v.
Jamestown Hous. Auth., 82 F.3d 1179, 1186 (1st Cir. 1996).
On September 3, 1993, a week before her due date, Ms. Sanchez was examined
by Dr. Roure, who determined that Ms. Sanchez's pregnancy was causing her to
suffer hypertension and that she should be hospitalized. Since Ms. Sanchez was
so close to her due date, her doctors decided to induce labor the next day.
Labor was induced the morning of September 4, 1993. Dr. Rosario was the
attending physician; also present at various times were several nurses,
including Nurse Elsie Oliveras. After several hours of contractions, the baby's
head emerged, but then retracted -- an indication (called the "turtle sign") that
the baby's shoulder was stuck.1 In response, Dr. Rosario instructed Nurse
Oliveras to push Ms. Sanchez's legs toward her head (putting her in the
"McRoberts position") and then to apply suprapubic pressure, so as to rotate
and free the baby's shoulder.
Nurse Oliveras seemed confused over how to execute these maneuvers. After
she attempted to put Ms. Sanchez in the McRoberts position, Dr. Rosario told
her in an urgent tone that she was performing the maneuver incorrectly and
directed her to do it the right way. Then, after being told to apply suprapubic
pressure, Nurse Oliveras repeatedly asked "How, how do I do this?"
At this point, Dr. Rosario sought outside help. He left the room for a minute or
so and returned with another doctor. The other doctor applied suprapubic
pressure, and soon after baby Natalie was delivered. It later became apparent
that as a result of the traumatic delivery, Natalie had suffered an injury to her
"brachial plexus" -- a net of nerves connecting the spinal cord with the arm; due
to the injury, she is unable to lift her left arm past 30 degrees. The specific
cause of the injury, crediting plaintiffs' evidence, was probably excessive
traction by Dr. Rosario during delivery, i.e., excessive pulling that overly
strained the nerves near the baby's neck.
8
On May 18, 1995, plaintiffs brought suit against Drs. Rosario, Roman, Roure,
and Santiago of the Centro Gineco-Obstetrico. The crux of the claim was that
the doctors were negligent in providing care to Ms. Sanchez by failing to advise
her that, due to her having diabetes, she bore a high risk of a complicated
natural childbirth, and that a Caesarian section was the safer alternative.
10
On September 28, 1998, plaintiffs settled with the physician defendants for
$400,000. The physicians remained parties in the case, however, as the subjects
of a cross-claim by Ashford. After trial, by way of a special verdict form, the
jury found both Ashford and the physicians negligent, attributing half the
liability for Natalie's injury to Ashford and half to the physicians. The jury
assessed plaintiffs' total damages to be $400,000; Ashford's resulting liability
was $200,000.
11
Subsequently Ashford moved to set aside the verdict for insufficient evidence.
The trial judge granted the motion, finding there was no evidence that
Ashford's nurses were undertrained, nor evidence that the nurses in any way
contributed to Natalie's injury. See Ponce v. Ashford Presbyterian Community
Hosp., 189 F.R.D. 31 (D. P.R. 1999). Plaintiffs now appeal.
II.
12
Plaintiffs' appeal is essentially three-pronged. They argue: first, that there was
sufficient evidence to support the jury's finding that Ashford was negligent;
second, that there was not sufficient evidence to support the jury's finding that
the physicians were negligent; and third, that the trial judge committed various
errors that led the jury to underestimate plaintiffs' damages.2 They ask this
court to reverse the trial court's decision to vacate the verdict against Ashford,
to enter judgment as a matter of law on Ashford's cross-claim against the
physicians, and to remand for a partial new trial limited to the question of
damages.
13
The third prong of plaintiffs' appeal is crucial to their case. Even if plaintiffs
were correct that there was sufficient evidence to find Ashford negligent but
insufficient evidence to find the physicians negligent -- leaving Ashford 100%
liable for plaintiffs' damages -- plaintiffs' victory would be a hollow one. The
resulting award against Ashford would be $400,000; yet plaintiffs have already
recovered precisely this amount in settlement from the physicians. Since Puerto
Rico (like most jurisdictions) prohibits double recovery in this context,
plaintiffs would net exactly zero. Villarini-Garcia v. Hospital Del Maestro, 112
F.3d 5, 7 (1st Cir. 1997). Thus, in order to prevail, plaintiffs must show that the
jury was erroneously led to underestimate damages, so as to reopen the
possibility of winning an award on remand exceeding their settlement.3
14
15
Ashford may not be found liable for any damages which may have been caused
by the negligent acts or omissions of the treating physicians. Plaintiffs may
only recover damages against Ashford if they establish . . . that the injury
suffered by baby Natalie Alicea Sanchez was proximately caused by Ashford's
negligent acts or omissions.
16
Plaintiffs argue that the instruction misled the jury to believe that it was
supposed to assess only that portion of plaintiffs' damages attributable to
Ashford, rather than plaintiffs' total damages; had the jury properly understood
the latter as its task, it would have reached a figure of $800,000, rather than
fifty percent of that.
17
However, plaintiffs did not object to the instruction on this ground at trial; to
the contrary, plaintiffs suggested the very language used in the instruction and
agreed that the instruction "should be clear that Ashford is liable for its own
negligence exclusively." Having waived the claim, Ashford is entitled to review
only for plain error, Drohan v. Vaughn, 176 F.3d 17, 21 (1st Cir. 1999), and we
find none.
18
The gist of the instruction was simply that Ashford could not be held
vicariously liable for the acts of the defendant physicians. Unlike in the case
plaintiffs rely on, Murray v. Ross-Dove Co., 72 F.3d 1 (1st Cir. 1995), the
instruction here did not specifically state -- or even suggest -- that in measuring
damages (as opposed to determining liability) the jury was to consider only
damages attributable to Ashford. Cf. id. at 2. Moreover, the special verdict form
-- which most immediately guided the jury's deliberations -- gave no indication
that the jury was to apportion damages on its own. The form did ask the jury to
apportion liability as between the defendants; but as to damages, the form
simply asked the jury to determine "what amount of damages" plaintiffs had
suffered, without limiting the question to those damages attributable to
Ashford.4 We thus see no error -- plain or otherwise -- in the guidance given the
jury on this point.
19
Plaintiffs next allege error in a separate instruction directing that the jury
"should consider the economic realities of Puerto Rico" in calculating Natalie's
lost earning capacity. At trial, the question of what the basis for that calculation
should be was controverted. Plaintiffs' damages expert based his calculation on
national statistics that did not include data from Puerto Rico, on the ground that
since Natalie was a child, one could not predict where she would reside in her
working adult life. Ashford argued that this ground was purely speculative and
that an accurate assessment of Natalie's lost earning capacity had to reflect the
dramatic differences in economic prospects between stateside residents and
residents of Puerto Rico. The judge agreed with Ashford, but declined to strike
the expert's testimony, as requested by Ashford; instead, as a curative
instruction, the judge told the jury to consider, in its assessment of lost earning
capacity, Puerto Rico's particular economic circumstances -- its unemployment
rate, the participation of women in its work force, and so on.
20
Puerto Rico, 116 P.R. Offic. Trans. 376, 393-94 (P.R. 1985). The judge's
instruction aligned with this dictate; the instruction properly directed the jury to
look to the economic data most specifically applicable to the case.5
Importantly, this directive was a soft one: the judge did not instruct the jury
that it had to rely exclusively on Puerto Rico data, or that it was forbidden from
relying in any way on the national data provided by plaintiffs' expert; he merely
instructed the jury that it "should consider" local economic conditions. So
benign an instruction leaves plaintiffs little ground for complaint.
21
22
Obviously, sending the two letters to the jury room was a mistake; but we do
not think it rose to the level of a prejudicial error. Ms. Sanchez's claim letter
indicated merely that plaintiffs' first move in this dispute was to seek
compensation from Dr. Rosario, whom, the letter said, was entirely responsible
for the injury; in response, the letter from Dr. Rosario's counsel vehemently
denied liability, urged Ms. Sanchez to drop her claim, and threatened
countersuit if she did not. Taken together, the letters gave no indication that the
two parties ever arrived at a settlement; indeed, it is not even clear from the
letters whether plaintiffs proceeded any further with their claim against Dr.
Rosario. Thus, while keeping the letters from the jury certainly would have
accorded with the trial court's general ruling not to allow in evidence of a prior
settlement, by themselves the letters were uninformative on this point. For the
letters to have resulted in prejudice (assuming that the jury actually viewed
them), they would have to have led the jury to hypothesize that a settlement had
occurred, to speculate as to its amount, and to subtract that amount from
plaintiffs' damages despite not having been instructed to do so. There is no
reason to believe that the jury digressed down this path -- especially given the
considerable sum at which the jury assessed plaintiffs' damages. Cf. Phav v.
Trueblood, 915 F.2d 764, 768 (1st Cir. 1990) (considering parsimonious jury
award as one indicator of tainted deliberations).
23
For these reasons, we find no error in the jury's computation of damages. Left
as it stands, the jury's award is redundant with plaintiffs' prior settlement and
hence constitutes an impermissible double-recovery. Accordingly, we affirm
the district court's decision to dismiss the case.
24
Notes:
*
Ashford timely raised the double recovery issue at trial, although the district
court did not address it in its written opinion. Ashford also properly preserved
the double recovery issue on appeal.
Plaintiffs did object to the special verdict form, but only to the portion
addressing liability, not the portion addressing damages. Specifically, plaintiffs
objected that there was insufficient evidence to find the physicians negligent,
so the verdict form should not ask the jury to apportion liability among the
doctors and the hospital.
There was no specific evidence to suggest that Natalie would spend her
working life somewhere else than Puerto Rico. Natalie and her family did move
to Massachusetts for a period around 1995; but the stay was for the purpose of
obtaining better medical treatment for Natalie. After Natalie's treatment
concluded, the family returned to Puerto Rico where they currently reside.